Cambodia: Resilience and Nutrition Security

Cambodia has made great improvements in decreasing child mortality and morbidity over the past decade. Most recent estimates of mortality rates of children aged under 5 showed 35 deaths per 1000 live births in 2014, down from 54 in 2010 and 83 in 2005. However, rates are still amongst the highest in the region and many more improvements need to be made.

The major causes of child mortality are neonatal, such as birth asphyxia (30%), followed by infections such as diarrhea and pneumonia. Malnutrition is a leading cause of disease burden in children under 5; approximately one third of child deaths are related to malnutrition.

In the South East Asia region, Cambodia has a maternal mortality rate second to only Laos. Maternal deaths account for 17% of overall mortality in Cambodian women aged 15-49 years. Thanks to the efforts of the Cambodian government and development organizations such as People in Need, in recent years Cambodia has managed to improve healthcare significantly, and the mortality of women giving birth has decreased by an average of 55% since 2005. In Takeo province, where PIN worked since 2008, maternal mortality has been reduced even further – by over 75%.

Despite this success, a Cambodian woman giving birth still undertakes a risk of not surviving the delivery that is thirty times higher than women in European countries. Four conditions are responsible for the majority of deaths: post-partum haemorrhage, pregnancy-induced hypertensive disorders (eclampsia and pre-eclampsia), obstructed labour and infections. Many of these conditions can be improved by proper antenatal care and skilled birth attendants.

PIN works in a number of integrated activities to improve maternal and child health across 4 provinces. We provide quality training sessions to improve the level of care provided by midwives and health centre staff, and we support and train health workers to conduct health promotion at a community level. These cover topics including newborn care, nutrition, and hygiene.

Finally, in 2013 PIN piloted an innovative programme using mobile phone technology in Kampong Chhnang Province. Mothers who subscribe to the programme receive regular voice messages with important information on how to take care of their newborn child and themselves.

Impact: We work in 4 provinces (Kampong Chhnang, Takeo, Koh Kong and Phnom Penh) across rural and urban populations in over 30 health centers and hospitals, with over 90 midwives and 50 health centre staff. Our ongoing projects will benefit over 45 thousand people.

Disaster Reduction and Early Warning (DREW)

We focus on building institutional capacity, technical training, disaster mitigation, or developing EWS, both at national, regional and urban level. With the project's activities, we are trying to increase the resilience of communities that are most threatened with regard to the various risks and disasters.

Sanitation Marketing

Locality: Kampot, Kompong Thom, Kratie, Prey Veng, Kompong ChnangWhen: Since the year 2018 until the year 2018Donors: Global Sanitation Fund

PIN has received the SanMark grant of the Cambodia Rural Sanitation and Hygiene Improvement Program led by Plan International through the Global Sanitation Fund. PIN has received this funding through having experience in both WASH behavioral change and promoting sustainable markets for socially beneficial products in rural Cambodia.

Many households in rural areas of Cambodia still do not have access to adequate and improved sanitation, which can lead to health problems for children and vulnerable people through ingesting contaminated food and water. An estimated 34% of children under-5 years old are stunted. In 2015, an estimated 40% of people in Cambodia still practiced ‘open defecation’, which is primarily due to a lack of adequate sanitation facilities.

The project aims to promote the use of latrines and increase the number of ‘Open Defecation Free’ villages within the rural target area. The SanMark approach aims to facilitate and enable local markets of sanitation products through both creating demand to purchase latrines among households, while also teaching businesses how to construct latrines. Household demand is promoted through a health education approach in target villages.

PIN is focusing on increasing the sustainability of the market for sanitation products through capacity building of local sanitation businesses. PIN’s support for local business includes components such as entrepreneurial training, book keeping, and marketing in surrounding villages.

Disaster Resilience and Water Management

Every year, thousands of Cambodians are affected by natural disasters. In 2013, more than 1.8 million people were affected by heavy rain and flash floods across 20 provinces causing more than US$350 million damage. Between 2015 and 2018, more floods occurred during the rainy season, and droughts during the dry season, causing major damages to several households’ livelihoods. These type of events are unfortunately likely to occur again in the future, and possibly with more intensity due to the changing climate. Thanks to funds from SDC, PIN in collaboration with Action Aid Cambodia are improving the access for at-risk populations in Cambodia to floods and drought early warning information and dissemination systems. PIN’s activities with the DRAW Project have a focus on the Early Warning System 1294 (EWS1294), which was launched in 2013 and is now scaling up. In the specific, people in risk prone areas who have registered to the EWS1294 can receive warnings that are timely and potentially lifesaving. Today EWS1294 has over 80,000 users, thus covering over 200,000 individuals in 11 provinces of Cambodia.

Building Disaster Resilient Communities IV

Locality: Kratie, Steung Treng, Phnom PenhWhen: Since the year 2017 until the year 2018Donors: ECHO

To further contributing to building the resilience of urban and rural communities in Cambodia, PIN took over the lead of the consortium of the ECHO funded project to build disaster resilient communities, working alongside ActionAid Cambodia and Dan Church Aid. PIN is currently engaging in activities with both institutions involved in Disaster Management and Disaster Risk Reduction, and communities affected by frequent disasters. At the institutional level, the Project Team is ensuring that national-level stakeholders increase their leadership and coordination, while authorities at the subnational level in urban and peri-urban areas increase their capacity in community based disaster risk reduction. At the community level, PIN is conducting promotional activities on DRR and the EWS1294, and continues the system’s scale-up process. Lastly, PIN and the Consortium are also working on the development of a cash transfer app, to ensure that disaster affected population has quicker access to emergency cash assistance.

Tepmachcha Scale Up

Locality: Bantey Meanchey, Siem Reap, Kampong Chnang, Kampong Thom When: Since the year 2017 until the year 2018Donors: DAI, USAID

In order for EWS1294 to actively function, with funds from USAID, PIN successfully installed six new prototype versions of the Tepmachcha devices in targeted flood prone areas of Cambodia. The Tepmachcha flood detection device is a solar powered, cellular data connected, sonar stream gauge, designed to record water levels in rivers and streams in Cambodia and send nearly instant early warning messages via mobile phone to people in affected areas. The devices are connected directly to PIN’s EWS1294 Early Warning mobile phone alert system and are providing near real time water level data in six different provinces across the country. During this project, PIN’s Disaster Management and Innovations Teams were able to increase the coverage of the flood detection to 4 further provinces (from the original 2 in 2016) and therefore contributed to improving extreme weather resilience for more than 40,000+ people in the designated areas.

Wash Resilience

Locality: Kampong Speu & KratieWhen: Since the year 2017Donors: UNICEF

PIN conducted a research report for UNICEF to understand the situation of climate resilience of water, sanitation and hygiene (WASH) systems in drought and/or flood prone areas of Cambodia.

Changing water systems in Cambodia are expected to increase incidence and severity of flooding and drought, which impact public health among vulnerable populations such as children 0 to 5 years old, pregnant, and elderly persons. Flooding can cause the spread of pathogens and contamination to water sources, whereas drought can impact hygiene practices. Cambodia’s vulnerability to climate change is primarily a result of 80% of the country lying within the Mekong river basin, which experiences large fluctuations of water levels between wet and dry seasons. On top of this, Cambodia is currently ranked 165th in the world in terms of access to improved water, with disparities remaining based on rural and urban populations and between economic quintiles.

Overall, PIN found that promoting climate-related resilience in WASH systems should account for both flooding and drought, as villages that were surveyed were vulnerable to both types of hazards. Flooding and drought were also shown to significant impact livelihoods, primarily through reduced agricultural output (including causing livestock deaths). Inadequate water during drought for impacts hygiene practices, while flooding is stated to pollute water through lack of waste management systems. Both flooding and drought led to increased rates of open defecation, either resulting from flooding of latrines that dysfunctional during flooding, or through lack of water for cleaning/flushing latrines.

The report also aims to identify methods of practical improvements in resilience for community and household based WASH infrastructure.

Improvement of health care access in Takeo

Locality: Takeo ProvinceWhen: Since the year 2015 until the year 2015Donors: Embassy of the Czech Republic in Cambodia

In Takeo Province, People in Need has improved healthcare access and community infrastructure by building 3 health centres, and PIN also donated medical equipment for training HC staff in specialized eye care, diagnosis and treatment. Additionally, one primary school was refurbished in Takeo in (3rd quarter of) 2015, ensuring safe and suitable conditions for children to attend school.

Access to health care, safe water and sanitation for displaced communities in Koh Kong province

The projects were implemented with the aim of contributing to positive behavioral change in relation to prenatal and postnatal care, nutrition and hygiene. We have also concentrated on training volunteers in the field of mobile health (mHealth) and key hygiene topics.

Improving the quality of mother and child health through sustainability of mHealth programming and content adaptation

Despite the progress in recent years, the province of Kampong Chhnang continues to have above-average newborn deaths (27 per 1,000 births) compared to other areas of Cambodia. The consequences of malnutrition are serious. As part of the project, we have been training clinicians in clinical skills or nutrition education in communities to prevent acute malnutrition of children. Thanks to the project, we have also expanded our innovative messaging system (mHealth), which provides services to families to improve neonatal health.

Beginning in Kampong Chhnang Province in 2013, the Healthy Family Community project uses mobile phone technology to deliver health messages regarding maternal and child health. Mothers and pregnant women who have registered receive automatic prerecorded voice messages to their phone which are designed to improve health behaviours and increase health service demand. These messages provide information and advice on a range of topics, such as avoiding harmful traditional health practices, and improving nutrition of the mother and baby.

The first program implemented in Kampong Chhnang delivered messages for the first 28 days of the baby’s life. As a result of our mHealth programme in 2014: 64% fewer mothers used traditional remedies to treat their baby’s cord stump; 48% fewer mothers consumed alcohol after birth; Twice the number of mothers could recognise danger signs in their baby; Admissions of children to health centres increased by more than 2.6 times.

Due its popularity and success, a new expanded service will deliver messages for the first 1,000 days of life, spanning from pregnancy until a child’s 2nd birthday. This is known as the window of opportunity, whereby better nutrition can have a life-changing impact on a child's future and help break the cycle of poverty.

Recently we receive funding from UNICEF for expanding mHealth activities to Kratie province and have since begun training midwives on the First 1000 days, Healthy Family Community programme.

Water, Sanitation and Hygiene (WASH)

Integral to its the community health promotion activities, PIN promotes healthy hygiene practices both within health centres and in the community. Together with social enterprise Wetlands Works!, PIN supported the pilot project of innovative flood proof latrines in a peri-urban community that is subject to annual flooding. In addition, PIN has partnered with Urban Poor Women Development (UPWD) to assess and improve the level of knowledge and awareness of hygiene practices within the impoverished communities of Phnom Penh. We have tailored lessons for community outreach based on our assessment of the knowledge, attitudes and practices of families within the community, in order to deliver the most relevant information to those who need it most.

Infrastructure Development

PIN works to improve access and standards of health infrastructure in rural and disadvantaged communities. This has included construction and renovation of health centres, postnatal rooms and WASH. In the province of Koh Kong, we have constructed a health centre in a remote, hard-to-access area where people were forced to relocate from their homes and communities due to economic development. Previously, these communities had no choice but to travel long distances to access health care, and now approximately 1500 households will receive convenient healthcare as a result of this new centre.

Moreover we have a partnership with RWC (Rainwater Cambodia) in Koh Kong for implementing a subsidized water jars and latrines project. This has been supplemented by CLTS (Community Led Total Sanitation) activities promoting handwashing and safe water use.

Newborn care and nutrition

People in Need provides quality training to improve the level of care focused on midwives and the staff of health centres. Training specializes in various areas such as resuscitation of newborn babies and infection control. In addition, PIN trained and supported health centres in the promotion of health care at community level. It focuses on the problems associated with breastfeeding and complementary feeding, holds cooking classes and demonstrations by mothers teach how their families prepare simple and nutritious meals.

In 2016 specialised training has taken place for health centre staff across two operation districts in Kampong Chhnang. Following that training, Post-Partum Hemorrhage and Anti-Shock garments (NASG) were donated to the HCs.